| Objective: To evaluate the removal effect of large molecules(PTH,β2-MG,CRP, AGEs,RA) and protein binding toxin(Hcy), the clinical efficacy for intractablehypertension, itching and other symptoms, and the nutritional status and the quality oflife on maintenance hemodialysis patients given hemoperfusion combined withhemodialysis.Subjects and methods:40maintenance hemodialysis (MHD) patients wererecruited from renal hemodialysis center of the first affiliated hospital of GuangzhouMedical College from January2011to January2012.Patients were randomly assignedto2groups, and treated with hemodialysis(HD) or hemoperfusion combined withHemodialysis (HP+HD) respectively.There were20samples in each group.Advanced glycation end products, homocysteine, parathyroid hormone, β2-Microglobulin, C-reactive protein and renin of all patients were tested before andafter the first treatment, and after12weeks of treament. The clearance effect of thoselarge molecules and protein binding toxin, the efficacy of those refractoryhypertension, itching and other clinical symptoms, the nutritional status and thequality of life were evaluated.Results: 1. The clearance effect of those large molecules and high protein binding rate toxin：1.1Group HP+HD compared with group HD:1.1.1After the first treatment:Hcy, PTH, AGEs and β2-MG index in HP+HD group was lower than that in HDgroup, CRP and PRA index in HP+HD group was higher than that of HD group, thedifference between the two groups was not statistically significant (P>0.05).1.1.2After12weeks treatment:AGEs, Hcy, PTH,β2-MG and PRA index in HP+HD group was lower than thatin HD group, CRP index in HP+HD group was higher than that in HD group, exceptPRA, the difference of other five indicators was statistically significant between thetwo groups (P<0.05).1.2In HP+HD group:From the initial treatment to12weeks of treatment, the four indicators: AGEs,Hcy, PTH and β2-MG were declining trend. After12weeks of treatment AGEsdeclined from759.22±227.80AU×10^-3/mg to351.17±266.58AU×10^-3/mg,Hcy declined from26.17±7.15umol/L to14.03±4.67umol/L, PTH declined from304.03±284.28pg/ml to134.23±105.30pg/ml,β2-MG declined from19.51±5.70mg/L to15.22±4.29mg/L.AGEs and Hcy index were significantly differentbetween after and before the initial treatment and between after12weeks oftreatment and before the initial treatment (P<0.05).PTH and β2-MG index weresignificantly different between after12weeks of treatment and before the initialtreatment (P<0.05), but not between after and before the initialtreatment(P>0.05). CRP and PRA index were not declining trend. It showed nosignificant difference between after and before the initial treatment and betweenafter12weeks of treatment and before the initial treatment(P>0.05).1.3In HD group:The six indicators which was compared, showed no significant differencebetween after and before the initial treatment(P>0.05). In addition, except Hcyand CRP,other four indicators were lower after12weeks of treatment than thatbefore the initial treatment, but the difference was not statistically significant (P>0.05).2. The effect of blood pressure and heart rate:The systolic blood pressure and diastolic pressure were higher in HP+HDgroup than those in HD group before and after the initial treatment, but lower after12weeks of treatment. It had statistical significance (P<0.05). Heart ratedifference between the two groups was not significant between after and beforethe initial treatment and between after12of weeks treatment and before the initialtreatment(P>0.05). In HP+HD group, systolic blood pressure and diastolic bloodpressure were higher after the initial treatment than those before the initialtreatment, but decreased after12weeks of treatment, the difference was notsignificant (P>0.05). In HD group, systolic blood pressure and diastolic bloodpressure were higher after the initial treatment than those before the initialtreatment, the difference was not significant (P>0.05), it was also increased after12weeks of treatment, and the difference had statistical significance(P<0.05).3. The symptoms of itching in group HP+HD after the initial treatment had a totalremission rate of30%,but0%in group HD. After12weeks of treatment, ingroup HP+HD had a total remission rate of94.1%, but only11.8%in group HD.The differences between the two groups had statistical significance both in afterthe initial treatment and after12weeks of treatment(P<0.05).4. The difference of plasma albumin between the two groups was not significant(P>0.05) both after the initial treatment and12weeks of treatment.5. Quality of life was assessed in8dimensions: in group HP+HD, scores of PhysicalFunction,Bodily Pain, General Health, Vitality, Mental Health were higher thanthose in group HD, the difference between the two groups was statisticallysignificant (P<0.05); in group HP+HD, scores of Role-Physical, Social Function,Role-Eemotional were higher than those in HD group, but there was no significantdifference (P>0.05).Conclusion:1.HP+HD can effectively remove AGEs, Hcy, PTH and β2-MG from maintenancehemodialysis patients.The effect is better than that of conventional hemodialysis; One time hemoperfusion combined with hemodialysis can effectively remove AGEs, Hcy,PTH,β2-MG. The index is even lower after12times of treatment. The effect ofhemoperfusion combined with hemodialysis for removing CRP and RA is poor,compared with conventional hemodialysis,it had no statistical significance.2.The efficacy of hemoperfusion combined with hemodialysis in maintenancehemodialysis patients with refractory hypertension is better than that of conventionalhemodialysis; it had no significant effect on heart rate.3.Hemoperfusion combined with hemodialysis can remarkably release intractablepruritus in maintenance hemodialysis atients.4.Nutritional status before and after the treatment in both groups have no significantdifference.5. Hemoperfusion combined with hemodialysis has positive effects on living qualityof in maintenance hemodialysis patients. |
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